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. 2021 Dec 27;13(12):2150-2160.
doi: 10.4254/wjh.v13.i12.2150.

Determination of "indeterminate score" measurements in lean nonalcoholic fatty liver disease patients from western Saudi Arabia

Yasir Mohammed Khayyat  1
Affiliations

Determination of "indeterminate score" measurements in lean nonalcoholic fatty liver disease patients from western Saudi Arabia

Yasir Mohammed Khayyat. World J Hepatol. .

Abstract

Background: Noninvasive measures to estimate liver fibrosis in lieu of biopsy in nonalcoholic liver disease (NAFLD) can broadly differentiate high vs low degrees of condition extent. However, an "indeterminate score" necessitates further clinical investigation and biopsy becomes essential, highlighting the need for identification of other noninvasive factors with accuracy for this midlevel extent and its prognosis. Lean NAFLD cases are of particular interest regarding this issue, as they present as otherwise healthy, and will benefit greatly from the less invasive assessment.

Aim: To estimate the agreement of two noninvasive assessment tools in lean NAFLD patients, and assess factors related to indeterminate scores.

Methods: Ultrasound-diagnosed NAFLD patients, without sign of other chronic liver disease (n = 1262), were enrolled from a tertiary private medical centre between 2016-2019. After grouping by body mass index (obese, overweight, and lean), each participant underwent FibroScan. NAFLD fibrosis score (NFS) was used for subclassification (lower, higher, and indeterminate). No patient underwent liver biopsy. The kappa statistic was used to assess inter-rater agreement between the three groups on liver fibrosis degree assessed via FibroScan and NFS. Indeterminate score among the three groups was assessed to identify factors that predict its determination.

Results: The NAFLD study cohort was composed of lean (159/1262, 12.6%), overweight (365/1262, 29%) and obese (737/1262, 58.4%) individuals. The lean patients were significantly younger (49.95 ± 15.3 years, P < 0.05), with higher serum high density lipoprotein (52.56 ± 16.27 mg/dL, P < 0.001) and lower prevalences of type 2 diabetes mellitus, hypertension and hyperlipidaemia. All groups showed a predominance of lower fibrosis degree. The lean NAFLD patients showed a significantly lower NFS (P < 0.001). Degree of agreement between FibroScan and NFS was fair between the lean and obese NAFLD categories, and moderate in the overweight category. NFS was predictive of indeterminate score. Age was a factor among all the body mass index (BMI) categories; other associated factors, but with less strength, were serum alanine aminotransferase in the overweight category and BMI in the obese category.

Conclusion: Lean NAFLD patients showed lower degree and prevalence of liver fibrosis by NFS; however, follow-up biopsy is still needed.

Keywords: Lean; Liver biopsy; Liver fibrosis; Nonalcoholic fatty liver disease; Obesity; Overweight.

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Conflict of interest statement

Conflict-of-interest statement: The author declares having no conflicts of interest related to this study and its publication.

Figures

Figure 1
Figure 1
Grades of liver fibrosis among body mass index classified groups based on FibroScan measurements. BMI: Body mass index.
See this image and copyright information in PMC

References

    1. Maheux A, Purcell Y, Harguem S, Vilgrain V, Ronot M. Targeted and non-targeted liver biopsies carry the same risk of complication. Eur Radiol. 2019;29:5772–5783. - PubMed
    1. Mehta R, Neupane A, Wang L, Goodman Z, Baranova A, Younossi ZM. Expression of NALPs in adipose and the fibrotic progression of non-alcoholic fatty liver disease in obese subjects. BMC Gastroenterol. 2014;14:208. - PMC - PubMed
    1. Yoneda M, Iwasaki T, Fujita K, Kirikoshi H, Inamori M, Nozaki Y, Maeyama S, Wada K, Saito S, Terauchi Y, Nakajima A. Hypoadiponectinemia plays a crucial role in the development of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus independent of visceral adipose tissue. Alcohol Clin Exp Res. 2007;31:S15–S21. - PubMed
    1. VanWagner LB, Armstrong MJ. Lean NAFLD: A not so benign condition? Hepatol Commun. 2018;2:5–8. - PMC - PubMed
    1. Ye Q, Zou B, Yeo YH, Li J, Huang DQ, Wu Y, Yang H, Liu C, Kam LY, Tan XXE, Chien N, Trinh S, Henry L, Stave CD, Hosaka T, Cheung RC, Nguyen MH. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5:739–752. - PubMed